Value of CT-derived Fractional Flow Reserve in the Context of Outpatient Cardiac CT in Germany: A Propensity Score Matched Analysis

Abstract

Purpose

Coronary artery disease (CAD) remains one of the leading causes of death in Germany. Since outpatient reimbursement for cardiac computed tomography angiography (CCTA) became available in 2024, non-invasive diagnostics have gained importance. CT-derived fractional flow reserve (FFR-CT) may increase the specificity of CCTA and reduce invasive procedures.

Materials and Methods

In this retrospective analysis, 640 consecutive patients with coronary stenosis >25% were included in outpatient CCTA. Among them, 107 underwent additional FFR-CT. After propensity score matching, two cohorts of 105 patients each were available for comparison. The primary endpoint was the positive predictive value (PPV) for hemodynamically relevant stenoses.

Results

Based on propensity score matching, FFR-CT showed a PPV of 88% compared to 73% in the group without FFR-CT. Patients with nonpathological FFR-CT results were mainly managed conservatively, whereas pathological values led to revascularization in more than 70%. In the control group without FFR-CT, invasive coronary angiographies without coronary intervention were significantly more frequent (27%). Correlation between FFR-CT and invasive FFR was strong (r = 0.92; ICC = 0.95).

Conclusion

Integration of FFR-CT in outpatient CCTA seems to improve diagnostic accuracy and reduce invasive procedures. It has the potential to combine anatomical and functional information and optimize treatment decisions in stable CAD.

Key Points

• FFR-CT has the potential to increase diagnostic accuracy and reduce invasive coronary angiographies.

• FFR-CT has a higher positive predictive value than CCTA.

• The correlation between FFR-CT and invasive FFR was high.

• In cases of pathological FFR-CT, revascularization was performed in >70% of patients

Citation Format

• Rottländer D, Fischer C, Mohsen Y et al. Value of CT-derived Fractional Flow Reserve in the Context of Outpatient Cardiac CT in Germany: A Propensity Score Matched Analysis. Rofo 2025; DOI 10.1055/a-2760-5485

Keywords

cardiac - angiography - coronary angiography

Publikationsverlauf

Eingereicht: 11. September 2025

Angenommen nach Revision: 20. November 2025

Artikel online veröffentlicht:
17. Dezember 2025

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